Orsolya Balogh

Moderate to severe psoriasis patients' subjective future expectations regarding health‐related quality of life and longevity

Unrealistic expectations regarding treatments and clinical outcomes may lead to disappointment about therapy and sub‐optimal compliance; nonetheless, these expectations have not been studied in psoriasis patients yet.

Disease burden of psoriasis associated with psoriatic arthritis in Hungary

INTRODUCTION Psoriasis is a frequent, chronic, systemic immune-mediated disease mainly affecting the skin and joints. AIM To assess health related quality of life and cost-of-illness in moderate to severe psoriasis associated with psoriatic arthritis. METHOD A cross-sectional questionnaire survey was conducted at two academic dermatology clinics in Hungary. RESULTS Fifty-seven patients (65% males) completed the survey with a mean age of 54.3±11.6 years and mean EQ-5D score of 0.48±0.4. Mean annual total cost was €8,977 per patient, of which 71% occurred due to biological therapy and 21% were indirect costs, respectively. Permanent work disability due to psoriasis accounted for €1,775 (95% of the indirect costs). Per patient costs of subgroups not receiving systemic therapy (21%), traditional systemic therapy (32%), and biological systemic therapy (47%) amounted to the sum of €1,729, €1,799, and €16,983, respectively. CONCLUSIONS Patients on biological therapy showed significantly better health related quality of life. As for health economics, the efficacy of systemic treatments is appropriate to be assessed together in patients with moderate to severe psoriasis associated with psoriatic arthritis, since actual health gain might exceed that reported in psoriasis or psoriatic arthritis separately.

[Quality of life and burden of disease in peripheral arterial disease: a study among Hungarian patients].

INTRODUCTION Peripheral arterial disease may occur in about of 14% of patients with high blood pressure, of which 1-3% suffer from chronic critical limb ischemia. Literature data on the quality of life according to the Fontaine stages are very limited. AIM The aim of this study was to assess the quality of life of Hungarian patients with peripheral arterial disease regarding Fontaine stages II, III and IV. METHODS The study was based on a cross-sectional survey, which was carried out in four angiologic centres. One hundred and two respondents with peripheral arterial disease (43% woman) were evaluated. The average age of the patients was 70 years (SD-10). RESULTS Based on the EQ-5D index, the results of the quality of life assessment with respect to Fontaine stages II, III and IV were 0.66, 0.35 and 0.18, respectively. In each stage the EQ-5D values were lower than the values of the age-matched average population. The results of the Pain Visual Analogue Scale (0-100 mm) were 38, 65 and 71 mm in Fontaine stages II, III and IV, respectively, and this showed a strong correlation with the EQ-5D (R = -0.68). In stage Fontaine IV the quality of life of the patients was significantly lower among those who had pain at rest and ALSO ulcer on the leg. CONCLUSIONS Peripheral disease with clinical symptoms causes significant reduction in quality of life which can be measured with EQ-5D. It becomes worse as we move along the Fontaine stages. While measuring the health gain in stage Fontaine IV, the health gain from the reduction of pain in rest and partial recovery from ulcer should be taken into account.

Effectiveness of prostanoids in patients with critical leg ischemia

UNLABELLED Prostanoids (alprostadil and iloprost) are used for the treatment of patients with critical limb ischemia in whom revascularization procedure is inadequate or proved to be unsuccessful. According to a Cochrane analysis (CD006544) prostanoids differ in their effects on rest-pain relief and ulcer healing. OBJECTIVES To study the efficacy and safety of prostanoids for critical limb ischemia. METHODS Systematic literature search and meta-analysis (mixed treatment comparison) was performed. RESULTS Seven randomized controlled trials including 964 patients were analyzed. Compared to placebo, both alprostadil (OR: 3.2 95% CI: 1.7-5.5 and OR: 1.8 95% CI: 0.6-4.3) and iloprost (OR: 2.7 95% CI: 1.7-4.2 and OR: 2.5 95% CI: 1.0-5.4) were more efficacious with regard to rest-pain relief and ulcer healing and the difference between the two prostanoids was not significant (OR: 1.2 95% CI: 0.7-1.9 and OR: 0.74 95% CI: 0.3-1.5). Adverse events occurred significantly more often with both drugs compared to placebo, however, they were less frequent with alprostadil than with iloprost (OR 0.2 95% CI: 0.1-0.3). CONCLUSIONS Prostanoids have favorable effect on rest-pain relief and ulcer healing in critical limb ischemia, without statistically significant difference between the two available drugs. The Cochrane study (CD006544) reported mistaken results due to defaults in the analysis.

Efficacy of prostanoids in patients with critical leg ischemia

UNLABELLED Prostanoids (alprostadil and iloprost) are used for the treatment of patients with critical limb ischemia in whom revascularization procedure is inadequate or proved to be unsuccessful. According to a Cochrane analysis (CD006544) prostanoids differ in their effects on rest-pain relief and ulcer healing. OBJECTIVES To study the efficacy and safety of prostanoids for critical limb ischemia. METHODS Systematic literature search and meta-analysis (mixed treatment comparison) was performed. RESULTS Seven randomized controlled trials including 964 patients were analyzed. Compared to placebo, both alprostadil (OR: 3.2 95% CI: 1.7-5.5 and OR: 1.8 95% CI: 0.6-4.3) and iloprost (OR: 2.7 95% CI: 1.7-4.2 and OR: 2.5 95% CI: 1.0-5.4) were more efficacious with regard to rest-pain relief and ulcer healing and the difference between the two prostanoids was not significant (OR: 1.2 95% CI: 0.7-1.9 and OR: 0.74 95% CI: 0.3-1.5). Adverse events occurred significantly more often with both drugs compared to placebo, however, they were less frequent with alprostadil than with iloprost (OR 0.2 95% CI: 0.1-0.3). CONCLUSIONS Prostanoids have favorable effect on rest-pain relief and ulcer healing in critical limb ischemia, without statistically significant difference between the two available drugs. The Cochrane study (CD006544) reported mistaken results due to defaults in the analysis.

Image Quality of Prospectively ECG-Triggered Coronary CT Angiography in Heart Transplant Recipients

OBJECTIVE Cardiac allograft vasculopathy (CAV) is among the top causes of death 1 year after heart transplantation (HTx). Coronary CT angiography (CTA) is a potential alternative to invasive imaging in the diagnosis of CAV. However, the higher heart rate (HR) of HTx recipients prompts the use of retrospective ECG-gating, which is associated with higher radiation dose, a major concern in this patient population. Therefore, we sought to evaluate the feasibility and image quality of low-radiation-dose prospectively ECG-triggered coronary CTA in HTx recipients. MATERIALS AND METHODS In total, 1270 coronary segments were evaluated in 50 HTx recipients and 50 matched control subjects who did not undergo HTx. The control subjects were selected from our clinical database and were matched for age, sex, body mass index, HR, and coronary dominance. Scans were performed using 256-MDCT with prospective ECG-triggering. The degree of motion artifacts was evaluated on a per-segment basis on a 4-point Likert-type scale. RESULTS The median HR was 74.0 beats/min (interquartile range [IQR], 67.8-79.3 beats/min) in the HTx group and 73.0 beats/min (IQR, 68.5-80.0 beats/min) in the matched control group (p = 0.58). In the HTx group, more segments had diagnostic image quality compared with the control group (624/662 [94.3%] vs 504/608 [82.9%]; p < 0.001). The mean effective radiation dose was low in both groups (3.7 mSv [IQR, 2.4-4.3 mSv] in the HTx group vs 4.3 mSv [IQR, 2.6-4.3 mSv] in the control group; p = 0.24). CONCLUSION Prospectively ECG-triggered coronary CTA examinations of HTx recipients yielded diagnostic image quality with low radiation dose. Coronary CTA is a promising noninvasive alternative to routine catheterization during follow-up of HTx recipients to diagnose CAV.

Arthritis psoriaticával társuló középsúlyos és súlyos psoriasis betegségterhe Magyarországon@@@Disease burden of psoriasis associated with psoriatic arthritis in Hungary

INTRODUCTION Psoriasis is a frequent, chronic, systemic immune-mediated disease mainly affecting the skin and joints. AIM To assess health related quality of life and cost-of-illness in moderate to severe psoriasis associated with psoriatic arthritis. METHOD A cross-sectional questionnaire survey was conducted at two academic dermatology clinics in Hungary. RESULTS Fifty-seven patients (65% males) completed the survey with a mean age of 54.3±11.6 years and mean EQ-5D score of 0.48±0.4. Mean annual total cost was €8,977 per patient, of which 71% occurred due to biological therapy and 21% were indirect costs, respectively. Permanent work disability due to psoriasis accounted for €1,775 (95% of the indirect costs). Per patient costs of subgroups not receiving systemic therapy (21%), traditional systemic therapy (32%), and biological systemic therapy (47%) amounted to the sum of €1,729, €1,799, and €16,983, respectively. CONCLUSIONS Patients on biological therapy showed significantly better health related quality of life. As for health economics, the efficacy of systemic treatments is appropriate to be assessed together in patients with moderate to severe psoriasis associated with psoriatic arthritis, since actual health gain might exceed that reported in psoriasis or psoriatic arthritis separately.

2012 – the success-year of the 20 year-old Hungarian adult heart transplant program

Az 1992. januar 3-aval elindult hazai felnőttsziv-atultetesi program szamos fejlődesi stadiumon ment at az elmult 20 evben. A kezdetben szinte tarsadalmi munkaban beindult tevekenyseg műkodesi kerete lassan valt szervezette. Az elmult ket evtized allando velejaroja volt az alacsony donacios aktivitas es a varolistas betegek alacsony szama, mindez azt eredmenyezte, hogy a lassan emelkedő műteti szamok ellenere a transzplantacios aktivitas folyamatosan elmaradt a kivanalmaktol. Az Eurotransplanthoz tortenő reszleges csatlakozasunk azonban uj kihivast jelentett a hazai felnőttsziv-atultetesi program szamara. Ezen uj kihivasoknak es elvarasoknak tortenő megfelelesi szandek azonban kikenyszeritette a teljes felnőttsziv-atultetesi program atszervezeset, uj alapokra helyezeset. A Semmelweis Egyetem Er- es Szivgyogyaszati Klinikajan 2011 ősze es 2012 tavasza kozotti fel evben szamos olyan strukturalis, szemleletmodbeli, kepzesi valtoztatast valositottak meg, amelyek hatasara a klinika transzplantacios kapacitasa megsokszorozodott, a transzplantacios tevekenyseg biztonsaga sokat javult. Az alapjaiban megujitott program eredmenyekent 2012-ben 131%-kal nőtt a klinikan elvegzett műtetek szama az előző evihez viszonyitva. A 86,63%-os 30 napos tulelesi ratajaval pedig a huszeves program legeredmenyesebb evet zarta. Orv. Hetil., 2013, 154, 863–867. | The Hungarian adult heart transplant program, which started in 1992, has changed gradually in the past 20 years. After the early enthusiasm of the first cases it changed significantly and it became an organized programme. However, low donation activity and moderate referral numbers to the national transplant waiting list slowed down the process therefore, heart transplant numbers did not fulfill expectations in the early years. After a moderate increase in 2007 transplant numbers have dropped again until recently when Hungary partially joined Eurotransplant network. Excess fundamental resources allocated to cardiac transplantation by health care professionals and reorganizing transplant coordination as well as logistics forced dramatic changes in clinical management. In 2011 and 2012 major structural changes had been made at Semmelweis University. The newly established transplant intensive care unit and the initiation of mechanical circulatory support and assist device programme increased transplant numbers by 131% compared to previous years, as well as it resulted an 86.63% 30-day survival rate, hence last year was the most successful year of cardiac transplantation ever. Orv. Hetil., 2013, 154, 863–867.Az 1992. januar 3-aval elindult hazai felnőttsziv-atultetesi program szamos fejlődesi stadiumon ment at az elmult 20 evben. A kezdetben szinte tarsadalmi munkaban beindult tevekenyseg műkodesi kerete lassan valt szervezette. Az elmult ket evtized allando velejaroja volt az alacsony donacios aktivitas es a varolistas betegek alacsony szama, mindez azt eredmenyezte, hogy a lassan emelkedő műteti szamok ellenere a transzplantacios aktivitas folyamatosan elmaradt a kivanalmaktol. Az Eurotransplanthoz tortenő reszleges csatlakozasunk azonban uj kihivast jelentett a hazai felnőttsziv-atultetesi program szamara. Ezen uj kihivasoknak es elvarasoknak tortenő megfelelesi szandek azonban kikenyszeritette a teljes felnőttsziv-atultetesi program atszervezeset, uj alapokra helyezeset. A Semmelweis Egyetem Er- es Szivgyogyaszati Klinikajan 2011 ősze es 2012 tavasza kozotti fel evben szamos olyan strukturalis, szemleletmodbeli, kepzesi valtoztatast valositottak meg, amelyek hatasara a klinika transzplantacios kapacitasa ...The Hungarian adult heart transplant program, which started in 1992, has changed gradually in the past 20 years. After the early enthusiasm of the first cases it changed significantly and it became an organized programme. However, low donation activity and moderate referral numbers to the national transplant waiting list slowed down the process therefore, heart transplant numbers did not fulfill expectations in the early years. After a moderate increase in 2007 transplant numbers have dropped again until recently when Hungary partially joined Eurotransplant network. Excess fundamental resources allocated to cardiac transplantation by health care professionals and reorganizing transplant coordination as well as logistics forced dramatic changes in clinical management. In 2011 and 2012 major structural changes had been made at Semmelweis University. The newly established transplant intensive care unit and the initiation of mechanical circulatory support and assist device programme increased transplant numbers by 131% compared to previous years, as well as it resulted an 86.63% 30-day survival rate, hence last year was the most successful year of cardiac transplantation ever.

[2012 -- the year of success in the 20 year-old adult heart transplant program of Hungary].

Az 1992. januar 3-aval elindult hazai felnőttsziv-atultetesi program szamos fejlődesi stadiumon ment at az elmult 20 evben. A kezdetben szinte tarsadalmi munkaban beindult tevekenyseg műkodesi kerete lassan valt szervezette. Az elmult ket evtized allando velejaroja volt az alacsony donacios aktivitas es a varolistas betegek alacsony szama, mindez azt eredmenyezte, hogy a lassan emelkedő műteti szamok ellenere a transzplantacios aktivitas folyamatosan elmaradt a kivanalmaktol. Az Eurotransplanthoz tortenő reszleges csatlakozasunk azonban uj kihivast jelentett a hazai felnőttsziv-atultetesi program szamara. Ezen uj kihivasoknak es elvarasoknak tortenő megfelelesi szandek azonban kikenyszeritette a teljes felnőttsziv-atultetesi program atszervezeset, uj alapokra helyezeset. A Semmelweis Egyetem Er- es Szivgyogyaszati Klinikajan 2011 ősze es 2012 tavasza kozotti fel evben szamos olyan strukturalis, szemleletmodbeli, kepzesi valtoztatast valositottak meg, amelyek hatasara a klinika transzplantacios kapacitasa megsokszorozodott, a transzplantacios tevekenyseg biztonsaga sokat javult. Az alapjaiban megujitott program eredmenyekent 2012-ben 131%-kal nőtt a klinikan elvegzett műtetek szama az előző evihez viszonyitva. A 86,63%-os 30 napos tulelesi ratajaval pedig a huszeves program legeredmenyesebb evet zarta. Orv. Hetil., 2013, 154, 863–867. | The Hungarian adult heart transplant program, which started in 1992, has changed gradually in the past 20 years. After the early enthusiasm of the first cases it changed significantly and it became an organized programme. However, low donation activity and moderate referral numbers to the national transplant waiting list slowed down the process therefore, heart transplant numbers did not fulfill expectations in the early years. After a moderate increase in 2007 transplant numbers have dropped again until recently when Hungary partially joined Eurotransplant network. Excess fundamental resources allocated to cardiac transplantation by health care professionals and reorganizing transplant coordination as well as logistics forced dramatic changes in clinical management. In 2011 and 2012 major structural changes had been made at Semmelweis University. The newly established transplant intensive care unit and the initiation of mechanical circulatory support and assist device programme increased transplant numbers by 131% compared to previous years, as well as it resulted an 86.63% 30-day survival rate, hence last year was the most successful year of cardiac transplantation ever. Orv. Hetil., 2013, 154, 863–867.Az 1992. januar 3-aval elindult hazai felnőttsziv-atultetesi program szamos fejlődesi stadiumon ment at az elmult 20 evben. A kezdetben szinte tarsadalmi munkaban beindult tevekenyseg műkodesi kerete lassan valt szervezette. Az elmult ket evtized allando velejaroja volt az alacsony donacios aktivitas es a varolistas betegek alacsony szama, mindez azt eredmenyezte, hogy a lassan emelkedő műteti szamok ellenere a transzplantacios aktivitas folyamatosan elmaradt a kivanalmaktol. Az Eurotransplanthoz tortenő reszleges csatlakozasunk azonban uj kihivast jelentett a hazai felnőttsziv-atultetesi program szamara. Ezen uj kihivasoknak es elvarasoknak tortenő megfelelesi szandek azonban kikenyszeritette a teljes felnőttsziv-atultetesi program atszervezeset, uj alapokra helyezeset. A Semmelweis Egyetem Er- es Szivgyogyaszati Klinikajan 2011 ősze es 2012 tavasza kozotti fel evben szamos olyan strukturalis, szemleletmodbeli, kepzesi valtoztatast valositottak meg, amelyek hatasara a klinika transzplantacios kapacitasa ...The Hungarian adult heart transplant program, which started in 1992, has changed gradually in the past 20 years. After the early enthusiasm of the first cases it changed significantly and it became an organized programme. However, low donation activity and moderate referral numbers to the national transplant waiting list slowed down the process therefore, heart transplant numbers did not fulfill expectations in the early years. After a moderate increase in 2007 transplant numbers have dropped again until recently when Hungary partially joined Eurotransplant network. Excess fundamental resources allocated to cardiac transplantation by health care professionals and reorganizing transplant coordination as well as logistics forced dramatic changes in clinical management. In 2011 and 2012 major structural changes had been made at Semmelweis University. The newly established transplant intensive care unit and the initiation of mechanical circulatory support and assist device programme increased transplant numbers by 131% compared to previous years, as well as it resulted an 86.63% 30-day survival rate, hence last year was the most successful year of cardiac transplantation ever.

Prosztanoidok hatásossága kritikus vé gtagischaemiában

UNLABELLED Prostanoids (alprostadil and iloprost) are used for the treatment of patients with critical limb ischemia in whom revascularization procedure is inadequate or proved to be unsuccessful. According to a Cochrane analysis (CD006544) prostanoids differ in their effects on rest-pain relief and ulcer healing. OBJECTIVES To study the efficacy and safety of prostanoids for critical limb ischemia. METHODS Systematic literature search and meta-analysis (mixed treatment comparison) was performed. RESULTS Seven randomized controlled trials including 964 patients were analyzed. Compared to placebo, both alprostadil (OR: 3.2 95% CI: 1.7-5.5 and OR: 1.8 95% CI: 0.6-4.3) and iloprost (OR: 2.7 95% CI: 1.7-4.2 and OR: 2.5 95% CI: 1.0-5.4) were more efficacious with regard to rest-pain relief and ulcer healing and the difference between the two prostanoids was not significant (OR: 1.2 95% CI: 0.7-1.9 and OR: 0.74 95% CI: 0.3-1.5). Adverse events occurred significantly more often with both drugs compared to placebo, however, they were less frequent with alprostadil than with iloprost (OR 0.2 95% CI: 0.1-0.3). CONCLUSIONS Prostanoids have favorable effect on rest-pain relief and ulcer healing in critical limb ischemia, without statistically significant difference between the two available drugs. The Cochrane study (CD006544) reported mistaken results due to defaults in the analysis.